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MATTERS OF THE HEART
“The heart has reasons that reason does not understand.”
-Jacques Benigne Bossuel
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DISEASES OF THE CARDIOVASCULAR SYSTEM
CARIOMYOPATHIES
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CANINE DILATED CARDIOMYOPATHY
OTHER BREEDS INCLUDE WOLFHOUNDS, GREAT DANES, AND COCKER SPANIELS
90% of cases occur in Doberman Pinschers and Boxers
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CANINE DILATED CARDIOMYOPATHY: PATHOPHYSIOLOGY
• DECREASED CONTRACTILITY FROM AN UNKNOWN CAUSE (viral?, carnitine deficiency?)– Decreased contractility = decreased cardiac
outputCO (CARDIAC OUTPUT) = SV (STROKE VOLUME) X HR (HEART RATE)
The amt. of blood that leavesThe heart
Amt. of blood ejected withEach cardiac contraction(affected by afterload, preload,and inherent contractility)
How often the heartcontracts
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CANINE DILATED CARDIOMYOPATHY: PATHOPHYSIOLOGY
• THE BODY COMPENSATES BY: 1. INCREASING THE HEART RATE
*this is done by sympathetic nervous system stimulation
2. TRYING TO INCREASE STROKE VOLUME BY INCREASING PRELOAD (this means that the body increases filling of the heart) *This is done by activation of the Renin-angiotensin-aldosterone system which leads to sodium and water retention
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THE WALLS OF THE HEART ARE WEAK, FLABBY, AND DILATED – THIS DILATION MAY CAUSE SEPARATION OF THE MITRAL VALVE LEAFLETSLEADING TO MITRAL REGURGITATION
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CANINE DILATED CARDIOMYOPATHY: CLINICAL SIGNS
LETHARGY, EXERCISE INTOLERANCE, COUGHING, WEIGHT LOSS, TACHYPNEA,SYNCOPE, SOFT MURMUR (WHERE?)
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CANINE DILATED CARDIOMYOPATHY:DIAGNOSIS
Enlarged, round heartDOBERMANS ARE DEEP CHESTED AND MAY NOT APPEAR TO HAVE SUCH ANENLARGED HEART ON RADIOGRAPHS
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CANINE DILATED CARDIOMYOPATHY: DIAGNOSIS
PULMONARY EDEMA PLEURAL EFFUSION
PATIENT MAY SHOW SIGNS OF LEFT-SIDED, RIGHT-SIDED, OR HEART FAILURE FROM BOTH SIDES
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CANINE DILATED CARDIOMYOPATHY: PATHOPHYSIOLOGY, DIAGNOSIS
• Constant stimulation of the heart by the sympathetic nervous system causes ventricular arrhythmias and myocyte death– Most common arrhythmias: VPC’s and ventricular
tachycardia, esp. in boxers & Dobies; other dogs may have APC’s and atrial fibrillation
ONE VPC
MULTIPLE VPCsCAUSING TACHY-CARDIA
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CANINE DILATED CARDIOMYOPATHY: DIAGNOSIS: ECHOCARDIOGRAM
http://www.youtube.com/watch?v=NSnh3qN2kR4&NR=1
PERFORMING AN ECHOCARDIOGRAM IS THE DEFINITIVE WAY TO DIAGNOSEDILATED CARDIOMYOPATHY
http://www.youtube.com/watch?v=7TWu0_Gklzo&feature=related
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CANINE DILATED CARDIOMYOPATHY: TREATMENT
INCREASES CONTRACTILITY
DIURETIC-ELIMINATES EXCESS FLUID
REDUCES FLUIDRETENTION
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CANINE DILATED CARDIOMYOPATHY: TREATMENT
DIETARY SUPPLEMENTS THAT MAY HELP IMPROVE HEART FUNCTION, ESPIF THERE IS A DEFICIENCY
COENZYME Q10TAURINE – USED IN COCKERSPANIELS AND CATS, MAINLY L-CARNITINE
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FELINE DILATED CARDIOMYOPATHYA globular-shaped heart withsevere dilation of all fourchambers. Depressedventricular contractileperformance occurs.Ventricular dilation distorts theatrioventricular valves leading tomitral regurgitation and atrialenlargement
ABNORMALLY THIN VENTRICULAR WALLS
ATROPHIED PAPILLARY MUSCLES
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FELINE DILATED CARDIOMYOPATHY
• In the 1980’s DCM in cats was one of the most commonly diagnosed heart diseases. It was discovered that this was caused by a deficiency of TAURINE, an amino acid.
• Since that time commercial foods have added taurine to feline diets, which has significantly decreased the number of cases of feline DCM
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DISEASES OF THE CARDIOVASCULAR
SYSTEM
CARDIOMYOPATHIES
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PATIENT PRESENTATION
http://www.youtube.com/watch?v=X-wLIoYTpOU
http://www.youtube.com/watch?v=Zp7CiC7SXjk
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FELINE HYPERTROPHIC CARDIOMYOPATHY
NEUTERED MALE CATS BETWEEN 1-16 YRS. OF AGE
THE MOST COMMON CARDIOMYOPATHY IN CATS!
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FELINE HYPERTROPHIC CARDIOMYOPATHY: CLINICAL SIGNS and DIAGNOSIS
• Soft, sytolic murmur• Gallop rhythms or other arrhythmias
– ECG: ↑ p wave duration, ↑ QRS width, sinus tachycardia
• Echo: shows ↑ ventricular wall thickness, dilated left atrium
• Acute onset of heart failure• Acute onset of systemic thromboembolism
– Hindlimb paresis– Cold rear legs– Painful rear legs
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FELINE HYPERTROPHIC CARDIOMYOPATHY
• THE PREDOMINANT PATHOLOGY OF THIS DISEASE IS LEFT VENTRICULAR HYPERTROPHY
• CAUSE: – Genetics– Related to abnormal myocardial myosin or
calcium transport within the muscles of the heart
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FELINE HYPERTROPHIC CARDIOMYOPATHY
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FELINE HYPERTROPHIC CARDIOMYOPATHY: DIAGNOSIS
http://www.youtube.com/watch?v=yNj-lQaUBao
http://www.youtube.com/watch?v=KvUFb4qZwmw&feature=related
http://www.youtube.com/watch?v=xlsq5tJpj04&feature=related
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FELINE HYPERTROPHIC CARDIOMYOPATHY: Pathophysiology
PROBLEM #1: The walls lose compliance and resist filling during diastole! (diastolic failure)
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FELINE HYPERTROPHIC CARDIOMYOPATHY: Pathophysiology• PROBLEM #2: If the left ventricle cannot fill
adequately with blood, the blood backs up into the left atrium (enlargement) → pulmonary veins → pulmonary edema!
• PROBLEM #3: The left atrium becomes dilated with blood → the blood becomes static → blood stasis leads to clot formation → clot becomes dislodged and trapped elsewhere in the arterial system → thromboembolism!
***90% of thrombi become lodged in the aortic trifurcation causing “saddle thrombus”***
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FELINE HYPERTROPHIC CARDIOMYOPATHY: SADDLE THROMBUS
ACUTE, PAINFUL CONDITION CAUSINGPARESIS, COLD REAR LEGS/FEET!
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FELINE HYPERTROPHIC CARDIOMYOPATHY: SADDLE THROMBUS
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FELINE HYPERTROPHIC CARDIOMYOPATHY: TREATMENT
OR
PROPRANOLOL (B-BLOCKER) DILTIAZEM (CALCIUM CHANNEL BLOCKER)
FUROSEMIDE (DIURETIC)
ANTICOAGULANT
ASPIRIN
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FELINE HYPERTROPHIC CARDIOMYOPATHY: TREATEMENT
• LASIX (furosemide): a diuretic used to treat pulmonary edema
• DILTIAZEM: a calcium channel blocker used to inhibit cardiac and vascular smooth muscle contractility; reduces blood pressure and cardiac afterload; overall improvement in diastolic function– Or Propranolol: a beta-blocker to decrease heart rate
and myocardial oxygen demand• ASPIRIN: an anticoagulant used to thin blood and
help prevent clot formation in HCM• TPA (Activase): serves as a fibrolysin resulting in
the breakdown of clots that have already formed– Or Heparin, Warfarin: acts on the coagulation factors to
inhibit the formation of a stable clot
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FELINE HYPERTROPHIC CARDIOMYOPATHY: CLIENT INFO
• There is no cure!– Cats with HCM may experience heart failure,
arterial embolism, or SUDDEN DEATH!– Cats whose heart rates stay below 200
beats/min have a better prognosis than those whose heart rate is >200 beats/min
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CANINE HYPERTROPHIC CARDIOMYOPATHY:
• An UNCOMMON canine disease, but the cause appears to be heritable
• CLINICAL SIGNS:– Fatigue– Sudden death– Tachypnea– Syncope– Cough
• BREEDS: German Shepherds, Rottweilers, Cocker Spaniels, and others